Prevalence and factors associated with the correlation between malnutrition and pain in hemodialysis patients.

Malnutrition and pain are common in patients with chronic kidney disease who undergo hemodialysis. Although both pain and malnutrition are associated with increased morbidity and mortality, few studies have explored the correlation between pain and nutritional status. This study aimed to investigate the factors associated with pain intensity in patients undergoing hemodialysis, focusing on the risk of malnutrition. This was a cross-sectional study conducted at a regional dialysis center in a large tertiary hospital. Convenience sampling was used to recruit adult patients who had undergone hemodialysis for more than three months. An interviewer-administered questionnaire was used to gather sociodemographic and clinical data related to dialysis status, comorbidities, and body mass index (BMI). Pain severity and pain interference with functioning domains of the Brief Pain Index (BPI) were used to assess pain, and the malnutrition inflammation score (MIS) was used to assess nutritional status. Descriptive and inferential statistics were used to report the findings. The data were analyzed using the 25th version of the Statistical Package for the Social Sciences (IBM-SPSS) software. Of the final sample of 230 patients, 63.0% were males and 37.0% were females, with an average age of 58.3 years. Almost one-third of the participants had a BMI within the normal range (33.9%), and nearly one-third had a BMI within the underweight range (33.9%). Slightly more than half had a normal nutritional status or mild malnutrition (54.8%), while just under half had moderate or severe malnutrition (45.2%). The prevalence of pain was 47.0%. At the multivariate level, the severity of pain was associated with malnutrition (p < 0.001). Pain interference with function was associated with marital status (p = 0.045), number of comorbidities (p = 0.012), and malnutrition (p < 0.001). The MIS was positively correlated with both the severity of pain and the interference score. Pain and malnutrition were found to be prevalent in patients undergoing hemodialysis. Pain severity was associated with malnutrition, and pain interference was associated with malnutrition, marital status, and the number of comorbidities. Hemodialysis treatment should follow a patient-tailored approach that addresses pain, nutritional status, and associated chronic conditions. In addition, pain assessment and management should be included in the curriculum of nephrology training programs.

Availability of Pediatric Services and Equipment in Emergency Departments: A Multicenter Study in Resource-Limited Settings.

OBJECTIVE: This study was conducted to assess the availability of equipment and supplies in the emergency departments of the hospitals in the West Bank of Palestine. METHODS: This study was conducted in a cross-sectional design using a data collection form that was specifically developed for this study. The standardized data collection form contained a detailed list of all essential pediatric emergency equipment and supplies. RESULTS: This study was conducted in a total of 30 hospitals all across the West Bank of Palestine. The median number of patients visiting the emergency department per day was 115.0, the median number of patients admitted to the hospital per day was 14.5, and the median number of pediatric patients visiting the emergency department per day was 6.0. The median number of pediatricians in the hospital was 4.0, the median number of pediatricians in the emergency department was 1.0, the median number of nurses in the hospital was 75.0, and the median number of nurses in the emergency department was 8.5. Both governmental and private hospitals lacked the equipment and supplies needed for monitoring, gaining vascular access, airway management, resuscitation medications, cervical immobilization equipment, and other equipment and supplies. CONCLUSIONS: Decision and policymakers might use the findings reported in this study to allocate resources to restock and increase the availability of pediatric emergency equipment and supplies. More studies are still needed to compare the outcomes of patients before and after restocking and increasing the availability of pediatric emergency equipment and supplies.

Knowledge, attitudes, and practices of pregnant women regarding epidural analgesia: a multicentre study from a developing country.

BACKGROUND: Epidural analgesia has emerged as one of the best methods that can be used to reduce labour pain. This study was conducted to assess awareness, attitudes, and practices of pregnant women who visited maternity and antenatal healthcare clinics about epidural analgesia during normal vaginal birth. METHODS: This multicentre study was conducted in a cross-sectional design among pregnant women using a pre-tested questionnaire. The study population in this study was pregnant women who visited maternity and antenatal healthcare clinics in Palestine. RESULTS: In this study, a total of 389 pregnant women completed the questionnaire. Of the pregnant women, 381 (97.9%) were aware of the existence of epidural analgesia, 172 (44.2%) had already used epidural analgesia, and 57 (33.1%) experienced complications as a result of epidural analgesia. Of the pregnant women, 308 (79.2%) stated that epidural analgesia should be available during vaginal birth. Of the pregnant women, 243 (62.5%) stated that they would use epidural analgesia if offered for free or covered by insurance. Multivariate logistic regression showed that women who were younger than 32 years, who have used epidural analgesia, and those who stated that epidural analgesia should be available during vaginal birth were 2.78-fold (95% CI: 1.54-5.04), 4.96-fold (95% CI: 2.71-9.10), and 13.57-fold (95% CI: 6.54-28.16) more likely to express willingness to use epidural analgesia, respectively. CONCLUSIONS: Pregnant women had high awareness of the existence, moderate knowledge, and positive attitudes towards epidural analgesia for normal vaginal birth. Future studies should focus on educating pregnant women about all approaches that can be used to reduce labour pain including their risks and benefits.

This study focused on what pregnant women at maternity clinics in Palestine know and think about getting epidural shots during normal births to help lessen the pain when women give birth. Most of the pregnant women have heard about epidural shots and said that these shots should be offered during normal birth. Most of the pregnant women said that they would consider using epidural shots once offered for free or covered by insurance. Younger women, those who had used an epidural before, and those who thought epidurals should be available during birth were more likely to want to use an epidural again.

A Comprehensive Analysis of Reported Adverse Events and Device Failures Associated with Esophageal Self-Expandable Metal Stents: An FDA MAUDE Database Study.

INTRODUCTION: Esophageal Stents are used to maintain esophageal lumen patency in esophageal strictures caused by intrinsic and/or extrinsic malignancies and the occlusion of concomitant esophageal fistulas. While data on the efficacy and safety of esophageal stents exist, comprehensive evaluation of adverse events is limited. The aim of this study is to investigate the reported adverse events and device failures associated with esophageal self-expandable metal stents (SEMS) using the FDA's Manufacturer and User Facility Device Experience (MAUDE) database. METHODS: Post-marketing surveillance data for the esophageal SEMSs were analyzed using the FDA's MAUDE database from January 2014 to December 10, 2023. The outcomes of interest were patient-related adverse events and device failures. Statistical analysis was performed using Microsoft Excel 2010 and SPSS. Pooled numbers and percentages were calculated for each adverse event. Continuous variables underwent analysis using a two-tailed student t test, and significance was set to p ≤ 0.05. RESULTS: During the study period, 548 MAUDE reports revealed 873 device failures and 186 patient-related adverse events. The most common device issues were stent activation, positioning, or separation problems (4 n = 403; 46.2%), followed by device detachment or migration (n = 109, 12.5%), and material problems (n = 93, 10.7%). Patient complications included dysphagia/odynophagia (10%), perforation, pain, and bleeding (each 7.6%). The most common device failures in over-the-wire (OTW) stents and through-the-scope (TTS) stents were activation, positioning, or separation problems (TTS: n = 183, 52.6% vs OTW: n = 220, 41.9%). Compared to OTW stents, TTS stents had higher migration and breakage (13.5% vs. 11.8%, p = 0.24), and (9.2% vs. 6.7%, p = 0.08) respectively, while OTW stents had more challenges with stent advancement or removal (5.1% vs. 0.3%, p < 0.001 and 4.6% vs 3.4%, p = 0.19, respectively) and material problems (14.7% vs. 4.6%, p < 0.001). Activation, positioning, and separation problems were the most frequent device failures in fully covered (FC) and partially covered (PC) stents (FC: n = 62, 32.8%, PC: n = 168, 43.5%). FC stents had higher migration rates (20.6% vs 9.8%, p < 0.001), while PC stents exhibited more material problems (17.4% vs. 5.8%, p < 0.001) and difficulties with advancing the stents (6.7% vs. 0%, p < 0.001). CONCLUSION: Our examination showed a prevalence of reported device complications associated with stent activation, positioning, and separation problems. Dysphagia or odynophagia emerged as the most frequently reported patient complication. Furthermore, our analysis, provides insights into TTS vs. OTW and FC vs. PC esophageal SEMSs, enabling endoscopists and manufacturers to better understand adverse events and potentially optimize device design for future iterations.

Factors associated with physical inactivity among Palestinians with type 2 diabetes mellitus treated in resource-limited settings.

This study determined the prevalence and the associated factors with meeting the recommended amount of physical activity among type 2 diabetes mellitus (T2DM) patients receiving care in resource-limited settings of the West Bank of Palestine. Physical activity was assessed using the World Health Organization's Global Physical Activity Questionnaire. Associations were examined using multivariate logistic regression. Of the 302 patients included, 117 (38.7%) met the recommended amount of physical activity. Being younger than 58 years [aOR = 2.1 (95% CI 1.0-4.3], were employed [aOR = 2.3 (95% CI 1.1-4.9)], had high income [aOR = 3.9 (95% CI 1.3-11.9)], had thought that physical activity was crucial for T2DM patients [aOR = 32.7 (95% CI 3.9-275.5)], did not have comorbidities [aOR = 2.2 (95% CI 1.1-4.4)], had normal weight [aOR = 2.8 (95% CI 1.3-6.0)], and those who were overweight [aOR = 2.6 (95% CI 1.1-6.0)] were more likely to meet the recommended amount of physical activity compared to the patients who were 58 years or older, had low income, did not think that physical activity was crucial for T2DM patients, had comorbidities, and were obese, respectively. There is a need to increase physical activity among T2DM patients in resource limited settings.

Adverse Events and Device Failures Associated with Pancreatic Stents: A Comprehensive Analysis Using the FDA's MAUDE Database.

INTRODUCTION: Pancreatic duct stents (PDS) are widely used for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. However, there is a paucity of data regarding the adverse events associated with PDS placement. This study aims to investigate the reported adverse events and device failures related to PDS, utilizing the Manufacturer and User Facility Device Experience (MAUDE) database maintained by the U.S. Food and Drug Administration (FDA). METHODS: Post-marketing surveillance data from January 2013 to December 8, 2023, were extracted from the FDA's MAUDE database to analyze the reports pertaining to the use of commonly used PDS. The primary outcomes of interest were device issues and patient-related adverse events. Statistical analysis was performed using Microsoft Excel 2010, with the calculation of pooled numbers and percentages for each device and patient adverse event. RESULTS: A total of 579 device issues and 194 patient-related adverse events were identified. Device issues were primarily attributed to stent deformation (n = 72; 12.4%), followed by migration of the device into the pancreatic duct or expulsion out of the duct (n = 60; 10.4%), and stent fracture/breakage (n = 55; 9.4%). Among the patient-reported adverse events, inflammation was the most common (n = 26; 13.4%), followed by reports of stents becoming embedded in tissue (n = 21; 10.8%) and stent occlusion/obstruction (n = 16; 8.2%). The most prevalent device failures associated with Advanix stents were material deformation, with perforation (n = 3, 30%) being the most frequently reported adverse event. Concerning Geenen stents, migration or expulsion of the device (n = 34, 16.9%) constituted the most common device-related adverse events, while inflammation (n = 20, 16.7%) was the most frequently reported patient-related issue. For Zimmon stents, migration or expulsion of the device (n = 22, 8.8%) were the most frequently reported device-related problems, whereas perforation (n = 7, 10.9%) and bleeding (n = 7, 10.9%) were the most frequent patient-related adverse events. CONCLUSION: Our findings highlight important device and patient adverse events that endoscopists and referring providers should be aware of before considering pancreatic stent placement.

Breastmilk calcium concentrations in Palestinian lactating women.

AIM: Breastmilk calcium concentrations can vary between lactating women and over the lactation period. This study assessed breastmilk calcium concentrations among Palestinian lactating women. METHODS: The demographic and dietary variables of the lactating women were collected using a questionnaire. The women provided a sample of about 5 mL of breastmilk using hand expression. Breastmilk calcium concentrations were quantified using an inductively coupled plasma-mass spectrometric method. RESULTS: Breastmilk samples were taken from 240 lactating women. The mean breastmilk calcium concentration was 285.4 ± 115.1 mg/L. Lower breastmilk calcium concentrations were associated with age, lactating period, unemployment, dissatisfaction with income and insufficient consumption of vitamins and minerals. CONCLUSION: Breastmilk calcium concentrations were affected by demographic variables of the lactating women and insufficient consumption of vitamins and minerals. The findings reported in this study are informative to healthcare providers and decision makers who might be interested in improving the health of lactating women and their infants.

A Rare Case of Antiphospholipid Syndrome With Concomitant Antithrombin III Deficiency: A Case Report.

Antithrombin (AT) deficiency and antiphospholipid syndrome (APS) are distinct but potentially overlapping disorders with significant implications for thrombosis. We present a case of a 28-year-old male with hereditary AT deficiency who subsequently developed primary APS. Despite the challenges of overlapping symptoms and anticoagulation therapy, a careful diagnostic approach revealed the coexistence of these rare conditions. The patient was successfully managed with long-term anticoagulation, hydroxychloroquine, and other supportive measures. This case underscores the importance of comprehensive laboratory testing, especially when managing patients with pre-existing anticoagulation needs.

Successful management of a distal clavicular fracture using Titanium elastic nail (TEN) fixation.

This case report presents a unique instance of a 25-year-old male patient successfully treated with Titanium elastic nail (TEN) for a distal clavicle fracture, a method typically reserved for midshaft clavicle fractures. Distal clavicular fractures, constituting 12%-15% of all clavicle fractures, often necessitate surgical intervention to avoid complications such as malunion and persistent pain. While standard surgical therapies include Kirschner wire and hook plate fixation, this case explores the benefits of TEN, known for minimal tissue disruption and faster recovery. The patient, who suffered a severe left shoulder injury after falling, underwent a minimally invasive TEN procedure. Post-surgery, he showed a significant reduction in pain and improvement in shoulder mobility, with radiographic evaluations confirming successful fracture reduction and stable fixation. The case underscores the potential of TEN as a viable alternative for distal clavicular fractures, though further research is needed to establish comprehensive guidelines for its application.

Aluminum Concentrations in Breast Milk Samples Obtained from Breastfeeding Women from a Resource-Limited Country: A Study of the Predicting Factors.

This study assessed aluminum concentrations in breast milk samples obtained from breastfeeding women in resource-limited countries, estimated daily intake of aluminum by breastfed infants, and identified predictors of higher breast milk aluminum concentrations. A descriptive analytical approach was used in this multicenter study. Breastfeeding women were recruited from different maternity health clinics in Palestine. Aluminum concentrations in 246 breast milk samples were determined using an inductively coupled plasma-mass spectrometric method. The mean breast milk aluminum concentration was 2.1 ± 1.5 mg/L. The mean estimated daily intake of aluminum by infants was 0.37 ± 0.26 mg/kg body weight/day. Multiple linear regression showed that breast milk aluminum concentrations were predicted by living in urban areas, closer to industrial areas, waste disposals, frequent use of deodorants, and less frequent use of vitamins. Breast milk aluminum levels among Palestinian breastfeeding women were comparable to those previously determined in occupationally unexposed women.

Fear of anesthesia for cesarean section among pregnant women: a multicenter cross-sectional study.

BACKGROUND: Fear of anesthesia for cesarean section delivery is an important health issue that should be addressed by anesthesiologists, obstetricians, and other providers of antenatal and perioperative healthcare. This multicenter study was conducted to assess the fear of anesthesia for cesarean section among Palestinian pregnant women and to identify the predictors of high fear. METHODS: The study was conducted in a cross-sectional design among Palestinian pregnant women in different antenatal healthcare clinics. The study participants were recruited using a convenience sampling procedure. The pregnant women were asked to respond to items in a questionnaire. RESULTS: In this study, a total of 394 pregnant women completed the questionnaires. Of the pregnant women, 280 (71.1%) have had cesarean delivery under anesthesia, and 104 (26.4%) elected cesarean delivery. Multiple linear regression showed that higher fear scores were predicted by having a university degree (p-value < 0.001), living in rural areas (p-value = 0.007), dissatisfaction with social life (p-value = 0.004), satisfaction with religious commitment (p-value = 0.001), having had cesarean delivery under anesthesia (p-value = 0.005), and preference of cesarean delivery (p-value < 0.001). CONCLUSION: Fear of anesthesia was prevalent among pregnant women in Palestine. Higher fear could be predicted by education level, place of residence, satisfaction with social life, satisfaction with religious commitment, having had cesarean delivery under anesthesia, and preference for normal delivery. Anesthesiologists, gynecologists and obstetricians, nurses, midwives, and other providers of antenatal and perioperative healthcare services should consider these factors while counseling pregnant women and addressing their fear of anesthesia.

Teaching approaches and satisfaction of medical students during anesthesia rotations: a multicenter cross-sectional study.

BACKGROUND: Anesthesia training is an important component of medical education. This multicenter study was conducted to determine the teaching approaches used during anesthesia training or rotations and to assess the satisfaction of the medical students. METHODS: This multicenter study was conducted in a cross-sectional design. The study was conducted among 5th and 6th year medical students who completed their anesthesia rotations in different training centers in Palestine. The data were collected using a questionnaire in adherence to the strengthening the reporting of observational studies in epidemiology statement. RESULTS: Questionnaires were returned by 385 medical students. The mean anesthesia rotation length was 12.4 ± 2.1 days. On average, the students witnessed 7.8 ± 4.9 procedures performed under general, regional, and local anesthesia in a week. Of the students, 135 (35.1%) and 126 (32.8%) stated that the educators always or often explained how and why they did procedures or techniques during the anesthesia rotation and assessed their baseline level of knowledge before giving new knowledge or explaining things. On the other hand, stepping back and allowing the trainees to work through, presenting articles or literature relevant to the case, and being open to trying new or different procedures or techniques were less often reported by the medical students. Less than half of the students were satisfied with their competencies gained through the anesthesia rotation. CONCLUSION: Educators used active and effective teaching or training approaches less frequently during the anesthesia rotations. The findings of this study also showed that the medical students were not satisfied with their competencies after their anesthesia rotations. More studies are still needed to determine the best ways to improve anesthesia rotations and medical education or training in Palestine.

Ventricular Tachycardia in an Elderly Male With Brugada Syndrome.

We present a case of Brugada syndrome in a 74-year-old patient who presented with urine retention and incidentally found to have non-sustained ventricular tachycardia (NSVT) on electrocardiogram (ECG) and telemetry. To reveal characteristic type 1 Brugada pattern, right-pericardial lead was placed in the third right intercostal space. No antiarrhythmics were started, a loop recorder was implanted, and on follow-up episodes of self-terminating sustained ventricular tachycardia (VT) were noted. The patient was started on quinidine with resolution of VT.

Conservative Management of a Distal Humerus Spiral Fracture Sustained During Arm Wrestling: A Case Report and Literature Review.

Arm wrestling is a popular recreational activity that involves intense and repetitive muscular contractions of the upper extremity. Arm wrestling can result in various musculoskeletal injuries, including bone fractures. Humeral shaft fractures, particularly spiral fractures, are the most common fractures resulting from arm wrestling. Here, we present a case of a 25-year-old male patient who sustained a distal humerus spiral fracture during an arm-wrestling competition. The patient was managed conservatively with external reduction, cast stabilization, and physiotherapy with good outcomes. Despite initial angulation and rotation, the fracture healed well, and the patient regained full function of his arm within eight weeks. This case highlights the biomechanical aspects and risk factors of this type of fracture during arm wrestling and the value of protective measures such as proper technique, training, and protective equipment. It also highlights the potential for conservative management in such cases.

Prevalence of preoperative anxiety among hospitalized patients in a developing country: a study of associated factors.

BACKGROUND: Preoperative anxiety is a health concern among patients scheduled for surgical interventions. Little is known about the prevalence of preoperative anxiety among patients in different healthcare systems of developing countries. This study was conducted to determine the prevalence of preoperative anxiety among patients undergoing surgery in Palestine. Another objective was to identify the factors associated with preoperative anxiety. METHODS: This study was conducted in a cross-sectional descriptive design. Patients scheduled for surgical interventions were interviewed using an interviewer-administered questionnaire. The questionnaire collected the demographic, clinical, and surgical variables of the patients. The questionnaire also contained the Amsterdam preoperative anxiety and information scale (APAIS), and a short version of the Spielberger state-trait anxiety inventory (STAIS-5/STAIT-5). RESULT: A total of 280 patients were included. The mean APAIS total score was 13.6 ± 5.9, the mean APAIS anxiety domain score was 8.3 ± 4.3, and the mean APAIS need for information domain was 1.6 ± 0.50. Of the patients, 76 (27.1%) had high anxiety and 160 (57.1%) expressed a high need for information. The higher APAIS anxiety scores were predicted by being female, having chronic diseases, being scheduled to be operated on within 24 h, and having experienced surgical complications. The mean STAIS-5 score was 10.0 ± 4.2 and the mean STAIT-5 was 10.3 ± 3.8. Of the patients, 140 (50.0%) had high state anxiety and 56 (20.0%) had high trait anxiety. Higher STAIS-5 scores were predicted by being female, younger than 42 years, and scheduled to be operated on within 24 h. Higher STAIT-5 scores were predicted by being female. A positive correlation was identified between APAIS total, APAIS anxiety, APAIS need for information, STAIS-5, and STAIT-5 scores. CONCLUSION: Preoperative anxiety was prevalent among patients scheduled for surgical operations in Palestinian hospitals. Anesthesiologists and other providers of perioperative care should screen preoperative patients who are female, have chronic diseases, are scheduled to be operated on within 24 h, and having had experienced surgical complications for preoperative anxiety. More studies are still needed to investigate the effects of the implemented measures on the prevalence of preoperative anxiety.

Photoinduced NiH Catalysis with Trialkylamines for the Stereodivergent Transfer Semi-Hydrogenation of Alkynes.

We report a selectivity-switchable nickel hydride-catalyzed methodology that enables the stereocontrolled semi-reduction of internal alkynes to E- or Z-alkenes under very mild conditions. The proposed transfer semi-hydrogenation process involves the use of a dual nickel/photoredox catalytic system and triethylamine, not only as a sacrificial reductant, but also as a source of hydrogen atoms. Mechanistic studies revealed a pathway involving photo-induced generation of nickel hydride, syn-hydronickelation of alkyne, and alkenylnickel isomerization as key steps. Remarkably, mechanistic experiments indicate that the control of the stereoselectivity is not ensuing from a post-reduction alkene photoisomerization under our conditions. Instead, we demonstrate that the stereoselectivity of the reaction is dependent on the rate of a final protonolysis step which can be tuned by adjusting the pKa of an alcohol additive.

Breastmilk cadmium levels and estimated infant exposure: a multicenter study of associated factors in a resource-limited country.

BACKGROUND: Despite the undisputed benefits of breastfeeding, infants might become exposed to xenobiotics that could be excreted into breast milk following maternal exposure. This study was conducted to assess breastmilk cadmium levels among lactating women in Palestine, a resource-limited country. Estimated daily intake (EDI) of cadmium via breastmilk was also calculated and predictors of high breastmilk cadmium levels and high infant exposure via breastmilk were identified. METHODS: This multicenter study was conducted using a descriptive-analytical design. The lactating women were recruited from different maternity and public health clinics in all regions of Palestine. Demographic variables and exposure to sources of cadmium were collected in an interviewer-administered questionnaire. Foremilk samples (about 5 mL) were collected in polyethylene tubes using the hand-expression technique. The breast milk samples were collected in the period between December 2020 and March 2021. A pre-validated method using inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify breastmilk cadmium levels. EDI values were calculated from the quantified breastmilk cadmium levels. RESULTS: Breastmilk samples were obtained from 256 lactating women. The mean breastmilk cadmium level was 0.34 (SD: 0.33) µg / L and the mean EDI of cadmium via breastmilk was 0.059 (SD: 0.058) µg / kg per body weight / day. Breastmilk cadmium levels were quantified in 92.6% of the breastmilk samples. Of the breastmilk samples, 13 (5.1%) had cadmium levels above those reported as "normal" by the World Health Organization (WHO). Multiple linear regression showed that higher breastmilk cadmium levels and higher EDI were predicted by being a smoker, living in a refugee camp, living close to an industrial area, living close to disposal of wastes, living close to paint shops, living in a house with peeling / chipping paint, frequent use of cosmetics, frequent use of hair dyes, and not using vitamins. CONCLUSION: The breastmilk cadmium levels and infant exposure were predicted by maternal exposure to sources of cadmium. The findings reported in this study are valuable to antenatal and postnatal healthcare service providers. More studies are needed to plan and implement measures to reduce breastmilk cadmium levels and infants' exposure to cadmium via breastmilk.

Pluripotency-independent induction of human trophoblast stem cells from fibroblasts.

Human trophoblast stem cells (hTSCs) can be derived from embryonic stem cells (hESCs) or be induced from somatic cells by OCT4, SOX2, KLF4 and MYC (OSKM). Here we explore whether the hTSC state can be induced independently of pluripotency, and what are the mechanisms underlying its acquisition. We identify GATA3, OCT4, KLF4 and MYC (GOKM) as a combination of factors that can generate functional hiTSCs from fibroblasts. Transcriptomic analysis of stable GOKM- and OSKM-hiTSCs reveals 94 hTSC-specific genes that are aberrant specifically in OSKM-derived hiTSCs. Through time-course-RNA-seq analysis, H3K4me2 deposition and chromatin accessibility, we demonstrate that GOKM exert greater chromatin opening activity than OSKM. While GOKM primarily target hTSC-specific loci, OSKM mainly induce the hTSC state via targeting hESC and hTSC shared loci. Finally, we show that GOKM efficiently generate hiTSCs from fibroblasts that harbor knockout for pluripotency genes, further emphasizing that pluripotency is dispensable for hTSC state acquisition.